File:The Principles and practice of gynecology - for students and practitioners (1904) (14581498108).jpg

Identifier: principlespracti00dudl (find matches)
Title: The Principles and practice of gynecology : for students and practitioners
Year: 1904 (1900s)
Authors: Dudley, E. C. (Emilius Clark), 1850-1928
Subjects: Gynecology
Publisher: Philadelphia : Lea Brothers & Co.
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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of the bladder 1 E. C. Dudley. Journal American Medical Association, March 27,1886. GENITAL FISTULjE. 601 —that i.<, to the lower margin of the fi.-tula—and held there withoutundue traction. A strip ot mucous memhrane across the bladder wastherefore denuded from side to side an inch in front of the uterus.This denudation was continued around the lateral and lower marginsof the fistula. The strip of denuded surface across the bladder was thendmwndown and stitched to the lower margin of the fistula X Z, Figure332. Thus the bhiddcr was divided into two parts, the upper closedpart communicating with the urethra and receiving the urine from theureters; the lower open part replacing the lost anterior vaginal wall.In other words, the part of the bladder-wall, situated between theline of denudation across the fundus of the bladder and the uterus,was utilized as a substitute for the lost vesicovaginal septum andanterior wall of the cervix. Tweuty-two sutures were used. Xot- FiGUEE 332.
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Section at X Z shows the fundus of the bladder stitched to the neck of the bladder. withstanding the ftulure of the nurse on the third day to keep thecatheter in place, and the consequent accumulation of several ouncesof urine in the bladder, union by first intention was complete. Thebladder, although reduced in size by the operation, has normally per-formed its functions ever since. It is large enough to enable thewoman to retain her urine all night. The writer is not aware thatanother similar operation has been recorded. Howard Kelly suggests a plan which might be adopted to advan-tage in place of the one just described. It is to dissect the bladderentirely free from the uterus, so as to make a wide opening betweenthe vagina and the peritoneum—that is, to make an anterior vaginalsection into the peritoneal cavity. The bladder-wall, anterior to the37 602 TRAUMATISMS. uterus, thus freed from its uterine attachments, may then be drawndown so as to close the fistula by a transverse li

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